Health Economics Evaluation Methods eJournal最新文献

{"title":"The Relationship Between Health Plan Type, Use of Specialty Medications, and Worker Productivity","authors":"P. Fronstin, M. Roebuck","doi":"10.2139/ssrn.3245199","DOIUrl":"https://doi.org/10.2139/ssrn.3245199","url":null,"abstract":"Specialty medications have piqued the attention of employers because spending on specialty medications has been increasing. In 2012, specialty medications accounted for 24 percent of total drug spending in the commercial market, but by 2016 specialty medications accounted for 36 percent. By 2020, specialty medications are expected to account for nearly one-half of total drug spending in the commercial market. Managing specialty medications is considered one of the most effective tactics when it comes to controlling health care costs. In this Issue Brief, the Employee Benefit Research Institute (EBRI) examines the impact of plan type on use of specialty medications. This paper also focuses on the impact that use of specialty medications both among workers and their dependents has on worker productivity. The analysis was conducted on nearly 100,000 unique individuals with rheumatoid arthritis (RA), Crohn's disease, ulcerative colitis, psoriasis, and multiple sclerosis (MS) using data from the Truven Health Analytics MarketScan® Research Commercial Claims and Encounters Database. Use of specialty medications among individuals with multiple sclerosis (MS): Among individuals with MS, there was no difference in the likelihood of filling a prescription for a specialty medication by type of health plan. However, among individuals with MS that had filled a specialty medication prescription, individuals with preferred provider organization/point of service (PPO/POS) and health reimbursement arrangement (HRA) plans used more specialty medications than those with health maintenance organization/exclusive provider organization (HMO/EPO) plans. There was no difference between those with health savings account (HSA)-eligible health plans and those with HMO/PPO coverage. Use of specialty medications among individuals with rheumatoid arthritis (RA), Crohn's disease, ulcerative colitis, and psoriasis: Plan type had no impact on whether any specialty medications were used, with one exception. Among individuals with RA, those with an HRA were less likely than those in HMO/EPO plans to use any specialty medications. Among individuals that had filled specialty medication prescriptions, we found mixed effects on the number of fills. For the most part, there were no differences in the number of fills by plan type. However, among individuals with RA, those in HRA plans filled fewer specialty medications than those in HMO/EPO plans. Among individuals with Crohn’s disease, those in PPO/POS plans used more specialty medications than those in HMO/EPO plans. Use of Specialty Medications and Worker Productivity: Any Use: We found few instances where productivity was affected by use of specialty medications. We did not find any relationship between any use of specialty medication and any use of sick or vacation leave, or number of days absent. We also did not find that any use of specialty medications affected whether a worker took short-term disability. However, we did find th","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131217021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Pharmacist Refusal Clauses on Contraception, Sexually Transmitted Diseases, and Birthrates","authors":"Justine Mallatt","doi":"10.2139/ssrn.3182680","DOIUrl":"https://doi.org/10.2139/ssrn.3182680","url":null,"abstract":"Emergency contraceptive drugs like Plan B are controversial, and there have been cases within at least 25 states of pharmacists refusing to provide the drug to patients. In response to pressure from activist groups on both sides of the debate, some states passed \"Patients' Rights Laws\" and other states passed \"Pharmacist Rights Laws\" dictating pharmacists' legal ability to refuse to fill emergency contraceptive prescriptions. Patients Rights Laws expand access to emergency contraception and protect patients' rights to receive prescribed drugs regardless of pharmacists' personal beliefs. Pharmacist Rights Laws restrict access to emergency contraception and favor pharmacists' rights of refusal. This paper studies substitution behavior among contraception spurred by both policies. I find that both types of laws cause a 7-18% increase in the prescribing rate of regular birth control pills, and both laws cause decreases in purchases of condoms as well as over-the-counter Plan B. There is not evidence that the policies have effects on rates of sexually transmitted diseases or birthrates on aggregate, however the states that pass the Pharmacist Rights Laws may experience decreases in birthrates for some groups. I find that policies that would be thought to either increase or decrease access to emergency contraception both cause substitution onto the birth control pill, which suggests that the policies may work through an information channel rather than by directly impacting rates of pharmacist refusal.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130644741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospect Theory and the Corrective Approach: Policy Implications of Recent Developments in QALY Measurement","authors":"S. Lipman, W. Brouwer, A. Attema","doi":"10.2139/ssrn.3195710","DOIUrl":"https://doi.org/10.2139/ssrn.3195710","url":null,"abstract":"Common health state valuation methodology, such as time trade-off (TTO) and standard gamble (SG), is typically applied under several descriptively invalid assumptions, for example assuming linear QALYs or expected utility (EU) theory. Hence, health state valuation exercises may lead to biased QALY weights. This bias may in turn affect decisions based on economic evaluations using such weights. Methods have been proposed to correct for these biases associated with different health state valuation techniques. In this paper we outline the relevance of prospect theory (PT), which has become the dominant descriptive alternative to EU, for health state valuations and economic evaluations. We provide an overview of work suggesting a solution for the dependence of QALY weights on the chosen methodology. We label this the corrective approach. By quantifying PT parameters, such as loss aversion, probability weighting and non-linear utility, it may be possible to correct TTO and SG for biases, in an attempt to produce more valid estimates of preferences for health states. Through straightforward examples this paper illustrates the effects of this corrective approach. Several unresolved issues currently limit the relevance of corrected weights for policy, these are listed and suggestions for research addressing these issues are provided. However, if validly corrected weights are available, we argue in favor of a deliberative approach to correcting biased health state valuations, in which policy makers utilize corrected weights. Finally we suggest that loss aversion premium for prevented health losses may be applied when deemed relevant.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131734735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Does Diabetes Influence the Impact of Aging on the Probability of Employment?","authors":"David P. Bernstein","doi":"10.2139/ssrn.3164567","DOIUrl":"https://doi.org/10.2139/ssrn.3164567","url":null,"abstract":"This paper examines how diabetes and complications from diabetes affect the impact of age on the probability a person nearing retirement age remains employed. The results presented here indicate that diabetics, especially those with complications tend to leave the workforce prior to 62 and becoming eligible for Social Security benefits. Diabetes and complications from diabetes also reduces the ability of people to remain in the workforce to increase their Social Security benefit. Increases in the eligibility age for receiving Social Security benefits would impose substantial hardships on diabetics. Programs that reduce the number of people with diabetes and eliminate diabetic-related complications could expand the workforce and stimulate economic growth. These benefits should be counted when considering the cost of programs to reduce diabetes.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123382862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adequate Use of Economic Evaluations Based on the Endpoints of a Registrative Clinical Trial: Cost-Minimization Analysis and the Return of the Living Dead","authors":"P. Russo, G. Favato, G. Rosano, T. Staniscia, F. Romano","doi":"10.2139/ssrn.3130284","DOIUrl":"https://doi.org/10.2139/ssrn.3130284","url":null,"abstract":"Cost-effectiveness analysis (CEA) has been widely applied to compare alternative options when a difference in health effects is observed. In contrast, a cost-minimization analysis (CMA) must be performed if the health effects of the alternatives can be considered reasonably similar. However, several authors have been suggested the death of CMA and supported the use of CEA alongside registrative clinical trials, even if the clinical end points of a study fail to demonstrate a statistically significant difference. The aim of the article is to discuss the potentially misleading implications of the inadequate use of CEA in translating results into clinical recommendations. A case study based on main findings from a published CEA evaluating the use of direct acting oral anticoagulants (DOACs), vitamin K antagonists, or antiplatelet drugs for the prevention of stroke in patients with atrial fibrillation, has been considered. \u0000The CEA recommends the use of apixaban as the first choice among DOACs, since it ranks the highest on the balance of efficacy, safety, and cost. However, no clinical evidence supporting this recommendation is available. In contrast, from a therapeutic perspective, several aspects support the preferential use of the other DOACs as a better first choice. \u0000In the case-study discussion, the step in which the incremental net benefit is calculated in the absence of at least one better alternative option either in regard to QALYs or total cost is critical and may promote incorrect conclusions and misleading clinical recommendations. \u0000The article proposed synoptic framework of the adequate use of economic evaluations based on the endpoints of registrative clinical trials, considering limitations on the use of CEAs and the expansion of CMA applications. Thus, CMAs should not only be limited to comparisons of products with evidence of efficacy from studies using an equivalence hypothesis test.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124873526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Economic Theory of Depression and its Impact on Health Behavior and Longevity","authors":"H. Strulik","doi":"10.2139/ssrn.3117040","DOIUrl":"https://doi.org/10.2139/ssrn.3117040","url":null,"abstract":"Abstract In this paper, I propose an economic theory of depression and its impact on health behavior and longevity. Based on studies from happiness research, depression is conceptualized as a drastic loss of utility and value of life for unchanged fundamentals. The model is used to explain how untreated depression leads to unhealthy behavior and adverse health outcomes: depressed individuals are predicted to save less, invest less in their health, consume more unhealthy goods, and exercise less. As a result, they age faster and die earlier than non-depressed individuals. I calibrate the model for an average American and discus how depression enlarges the socioeconomic gradient of health and consider feedback effects of depression on earnings and of physical exercise on depression as well as a variety of depression shocks. Delays in treatment for depression in young adulthood are predicted to have significant repercussions on late-life health outcomes and longevity.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"228 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130755112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Health Expenditures on Economic Growth of Cameroon: A Literature Review Perspective","authors":"Professor Alain Ndedi, Annita C Metha, Florence Nisabwe","doi":"10.2139/ssrn.3036510","DOIUrl":"https://doi.org/10.2139/ssrn.3036510","url":null,"abstract":"Health expenditure consists of all expenditures or costs for medical care, prevention, promotion, rehabilitation, community health activities, health administration and regulation and capital formation with the predominant objective of improving health in a country or region. According to WHO (2015), globally in 2006, expenditure on health was about 8.7% of gross domestic product, with the highest level in the Americas at 12.8% and the lowest in the South-East Asia Region at 3.4%. This translates to about US$ 716 per capita on the average but there is tremendous variation ranging from a very low US$ 31 per capita in the South-East Asia Region to a high of US$ 2636 per capita in the Americas. This paper intends to shows that health expenditure is a fundamental determinant of economic growth of every nation and that increasing expenditure on health leads to higher growth rates. Cameroon should therefore endeavor to meet and surpass the target of the Abuja declaration of 2001. One possible measure that could be taken to raise funds to meet this target could be by increasing for examples taxes on products such as cigarettes and other products of ostentation and rechanneling the extra revenue generated to investment in healthcare. One of the important drawbacks to funding to Cameroon is poor governance, thus measures to assure a fluid target based expenditure is imperative. In countries where poor governance is alarming, as the World Bank states, increasing public spending both from external donors and the government does not necessarily lead to the desired development outcomes. (WHO, 2013) Performance based financing can be an important mechanism that potential donors and government agencies can use. It is also believed to increase transparency and accountability in achieving targets. (Meessen, Hercot, Noirhomme, Ridde, Tibouti, Tashobya et al. 2011) Meessen et al. also argues that it improves the allocative efficiency of resources especially in low-income developing countries like Cameroon where resources are quite limited. Thus an efficient financing mechanism with greater emphasis on the processes leading to the performance goal is then necessary and imperative. This paper attempts just to show the linkages between increasing health care expenditures and economic growth.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121133251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Social Networks on the Effect of Retirement on Cognition","authors":"F. Hanemann","doi":"10.2139/ssrn.2979265","DOIUrl":"https://doi.org/10.2139/ssrn.2979265","url":null,"abstract":"English Abstract: This paper examines the role of social networks as a potential mechanism in the relationship between retirement and cognitive decline. In a first step, I analyze the effect of retirement on different social network characteristics using novel panel data of 19,999 respondents on social networks from wave 4 and wave 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE). In a second step, I estimate the effect of retirement on cognition under consideration of changing social network sizes. Applying instrumental variable fixed effects regressions based on country-specific statutory eligibility ages allows controlling for unobserved individual heterogeneity and endogeneity of the retirement decision. The results suggest that retirement leads to an increase in the number of close family members named as confidants indicating that the social network becomes more kin-oriented after retirement. However, adding close family members to the social network does not have a significant effect on cognition. In turn, adding non-family members like friends or colleagues to the social network has a positive impact on the cognitive performance. Since I do not find that retirement impacts the number of friends or colleagues significantly, I cannot claim social networks to be the explaining underlying mechanism in the relationship between retirement and cognitive decline. \u0000German Abstract: Ich untersuche die Rolle von sozialen Netzwerken als moglichen Mechanismus in dem Zusammenhang zwischen Ruhestand und dem Ruckgang kognitiver Fahigkeiten. Im ersten Schritt analysiere ich den Effekt von Ruhestand auf verschiedene Eigenschaften des sozialen Netzwerkes mithilfe von Langsschnittdaten 19.999 Befragten des Survey of Health, Ageing and Retirement in Europe (SHARE). Im zweiten Schritt untersuche ich den Effekt von Ruhestand auf Kognition unter Berucksichtigung der Grosenanderung des sozialen Netzwerkes. Durch die Anwendung eines Paneldatenmodells mit fixen Individualeffekten und durch den Einsatz von Instrumentvariablen kann fur Endogenitatsprobleme kontrolliert werden. Die Ergebnisse zeigen, dass Ruhestand zu einem Anstieg in der Anzahl der nahen Familienmitglieder im sozialen Netzwerk fuhrt. Allerdings hat dieser Anstieg keinen signifikanten Einfluss auf die kognitiven Fahigkeiten. Im Gegensatz dazu finde ich einen signifikant positiven Effekt auf Kognition, wenn Nicht-Familienmitglieder wie Freunde oder Kollegen neu in das soziale Netzwerk aufgenommen werden. Allerdings ist dieser Anstieg von Nicht-Familienmitgliedern nicht mit dem Eintritt in den Ruhestand verbunden, sodass ich die sozialen Netzwerke nicht als den erklarenden Mechanismus zwischen Ruhestand und Kognition herausstellen kann.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124727808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Medicare Coverage for the Chronically Ill on Health Insurance, Utilization, and Mortality","authors":"M. Andersen","doi":"10.2139/ssrn.2937364","DOIUrl":"https://doi.org/10.2139/ssrn.2937364","url":null,"abstract":"I study the effect of the 1973 expansion of Medicare coverage to individuals with End-Stage Renal Disease (ESRD) on insurance coverage, health care utilization, and mortality. Between the ESRD expansion and a simultaneous expansion of Medicare coverage to long-term Social Security Disability Insurance (SSDI) recipients, insurance coverage increased by 4.4 to 8.3 percentage points and the bulk of the increase in insurance coverage was due to an increase in Medicare coverage. The expansion was also associated with an increase in physician visits and a seven log point reduction in mortality from kidney disease, which I replicate in cross-country comparisons. Lastly, I provide evidence for two mechanisms that affected mortality: 1) an increase in access to and use of treatment, which is plausibly driven by changes in insurance coverage; and 2) an increase, by 1975, in entry of dialysis clinics in areas with a greater burden of kidney disease in 1971. Based on changes in the ages at which people died form kidney disease and all other causes, the ESRD program cost between $29000 and $245000 per life year saved, which includes a range of welfare improving values.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"97 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128807283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to Organize Tiered Competition for Prescription Drugs?: Formulary Structure and Bargaining Process","authors":"T. Cui, Preyas S. Desai, Huihui Wang","doi":"10.2139/ssrn.2891566","DOIUrl":"https://doi.org/10.2139/ssrn.2891566","url":null,"abstract":"Most prescription purchases in the US are covered by health insurance. Insurance companies typically develop a formulary structure to reduce the drug costs and improve patients’ access to drugs. In this paper, we study how the formulary structure affects price competition between competing drugs, which in turn affects market shares and the total market size. We characterize an insurance plan’s optimal strategy in terms of the number of drugs in the formulary, patients’ copay amount, and the structure of the bargaining process. \u0000We develop a game-theoretic model of strategic interactions among an insurance plan and two manufacturers of competing patent-protected drugs. The insurance plan in our model can negotiate prices with each drug company in return for providing insurance coverage to their products. We show that the insurance plan’s ability to accomplish cost- and access-related objectives varies significantly across different formulary structures and bargaining processes. Specifically, the insurance plan can better meet its objectives by putting both drugs in the formulary when the cross-price effects are not very large. On the other hand, when the cross-price effects are sufficiently strong, the insurance plan’s optimal strategy is to include only one drug in the formulary. Our analysis further suggests that sequential bargaining is better for the insurance plan than simulatenous bargaining. Although some of the gains to the insurance plan come at the expense of drug companies, there are cases in which the creation of a formulary may also benefit one or both drug companies, resulting in a win-win situation.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127892095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}